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Paraneoplastic neurologic disorders in small cell lung carcinoma: A prospective study
Paul Gozzard1, Mark Woodhall2, Caroline Chapman2
1From the Nuffield Department of Clinical Neurosciences (P.G., M.W., A.N., P.W., A.V., B.L.), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Division of Medical Sciences & Graduate Entry Medicine (C.C.), University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; and Division of Neurology (P.M.), Queen's Medical Centre, Nottingham, United Kingdom. p.gozzard@nhs.net.
Objective:
To determine the frequency and range of paraneoplastic neurologic disorders (PNDs) and neuronal antibodies in small cell lung carcinoma (SCLC).
Methods:
Two hundred sixty-four consecutive patients with biopsy-proven SCLC were recruited at the time of tumor diagnosis. All patients underwent full neurologic examination. Serum samples were taken prior to chemotherapy and analyzed for 15 neuronal antibodies. Thirty-eight healthy controls were analyzed in parallel.
Results:
PNDs were quite prevalent (n = 24, 9.4%), most frequently Lambert-Eaton myasthenic syndrome (3.8%), sensory neuronopathy (1.9%), and limbic encephalitis (1.5%). Eighty-seven percent of all patients with PNDs had antibodies to SOX2 (62.5%), HuD (41.7%), or P/Q VGCC (50%), irrespective of their syndrome. Other neuronal antibodies were found at lower frequencies (GABAb receptor [12.5%] and N-type VGCC [20.8%]) or very rarely (GAD65, amphiphysin, Ri, CRMP5, Ma2, Yo, VGKC complex, CASPR2, LGI1, and NMDA receptor [all <5%]).
Conclusions:
The spectrum of PNDs is broader and the frequency is higher than previously appreciated, and selected antibody tests (SOX2, HuD, VGCC) can help determine the presence of an SCLC.
